SHM Converge Scientific Abstract ePoster Gallery-Misattributed Agitation: Psychiatric Mimicry in Neurosarcoidosis

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This case describes a 52-year-old man with pulmonary sarcoidosis and epilepsy who presented with paranoia, agitation, and disorganized behavior, initially leading to psychiatric admission. Further history revealed known neurosarcoidosis diagnosed four years earlier. His symptoms had previously improved with high-dose steroids but worsened during a recent prednisone taper, raising concern for active neurologic disease rather than a primary psychiatric disorder.<br /><br />Brain MRI showed progression of confluent hyperintensities and leptomeningeal enhancement involving the bilateral frontal and anterior temporal lobes, findings consistent with neurosarcoidosis. Cerebrospinal fluid testing demonstrated elevated ACE and IgG, while infectious and autoimmune studies were negative. Because his disease progressed despite corticosteroid treatment, infliximab was started for steroid-refractory neurosarcoidosis, and he gradually improved neuropsychiatrically.<br /><br />The discussion emphasizes that sarcoidosis most commonly affects the lungs, but neurologic involvement occurs in about 5–15% of patients. Neurosarcoidosis can affect the meninges, brain, spinal cord, or peripheral nerves, producing a wide range of symptoms. Frontal and temporal lobe involvement can present with personality changes, paranoia, agitation, and executive dysfunction, closely mimicking psychiatric illness. Diagnosis depends on clinical presentation, MRI, CSF findings, evidence of systemic sarcoidosis, and exclusion of other causes. Corticosteroids are first-line therapy, but anti-TNF-α agents such as infliximab are used when disease is refractory.<br /><br />Key takeaway: psychiatric symptoms in patients with sarcoidosis should prompt evaluation for neurosarcoidosis, because misdiagnosis may delay appropriate treatment. Escalation to biologic therapy should be considered when symptoms and imaging worsen despite steroids.

Asset Subtitle

Harleen K. Sidhu

Meta Tag

Author List Harleen K. Sidhu, Jasmeet Sandhu, Shakthi Raman

Category Clinical Vignettes

Concept Neurosarcoidosis

Concept Corticosteroid

Concept Magnetic Resonance Imaging

Concept Leptomeningeal Enhancement

Concept Infliximab

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Harleen K. Sidhu

Track Adult

Keywords

neurosarcoidosis

pulmonary sarcoidosis

psychiatric symptoms

frontal lobe involvement

temporal lobe involvement

leptomeningeal enhancement

corticosteroid taper

cerebrospinal fluid ACE

infliximab

steroid-refractory disease

Neurosarcoidosis

Corticosteroid

Magnetic Resonance Imaging

Leptomeningeal Enhancement

Infliximab